Kosova Health Technology Management Assessment, January
2005

Sonia Pinkney and Vicky Young

Executive Summary

As follow-up to the October
2004 Health Technology Management (HTM) Seminar, two clinical
engineering mentors were sent to Kosova for three weeks to support and
review the current status of HTM. The mentors visited all six health
authorities accompanied by a senior Ministry of Health (MoH)
representative, Dr. Sami Rexhepi, and a Prishtinë clinical
engineer, Shema Çitaku. These visits typically included meetings
with the regional healthcare administration, a visit to the regional
Biomedical Engineering Departments (BMEDs), and tours of the equipment
intensive clinical areas in the main regional hospitals. Two local
Family Medical Clinics (FMCs), one Institute of Public Health
Laboratory and one non-regional hospital were also visited. The three
main goals of the trip are presented and summarised below:

1. To assess the
current situation of biomedical engineering (BME) services

The six BMEDs in Kosova are
currently not formally linked. The BMEDs are organized either under the
Department of Technical Services or report directly to the Operations
Director.

The hospitals are under the direction of the MoH's Regional Health
Authorities whereas the smaller Family Medical Clinics and Institutes of
Public Health are under the direction of their Municipalities. All BMEDs
support their regional hospitals, but two of them (Pejë and
Gjakova) are also currently supporting their respective FMCs through a
memorandum of understanding. There is interest in all other regions for
BME services to support healthcare facilities in the municipality.

The BMEDs typically support all medical equipment except for
haemodialysis equipment (supported by
Technical Services). However, the BMETs are limited in what equipment
they can support based on their
training, experience and resources (e.g., manuals). They currently
cannot support the more complex medical equipment such as ventilators,
anaesthesia equipment, scopes, specialised lab equipment, large
sterilizers, and radiology equipment.

Internal strengths:

BMEDs have established a medical
technology support service that clinicians can access to deal with
malfunctions, breakdowns or operator errors. BME collectively has
repaired 60-90% of all requests and repaired over 1000 items in the
last 14 months with small to non-existent financial support for new
parts.

There is strong co-operation and
motivation among the site specific teams

As of November 2004, BME has a strong
HTM Champion in the Minister of Health (Dr. Sami Rexhepi, right)

Sami Rexhepi, MD,
Ministry of Health BME Leader

Internal weaknesses:

The communication and support network for the
BMEDs is just starting to develop, but it needs continual effort in
order to strengthen these relationships and promote HTM issues and
needs.

BME staff does not have some of the basic
requirements to perform HTM efficiently and effectively (e.g., no parts
budget, few manuals, unreliable internet, difficulty accessing external
telephone, etc.).

BME are starting to offer other services
beyond equipment repair (e.g., informal clinical training), but
currently do not have a consolidated and complete inventory and most
sites are not performing comprehensive scheduled maintenance.

External threats:

It is yet to be determined how Kosova's
uncertain political and economical future, as well as a new Minister of
Health, will impact HTM & BME.

There is a risk that the existing BMEDs will
dissolve due to a lack of support and a growing private sector.

External opportunities:

There is a strong demand for BME services
beyond the MoH main regional hospitals. BMEDs' can expand their clients
to include the municipality healthcare facilities and surrounding
private clinics. Revenue generated can be used in employee retention
strategies (e.g., staff training).

2. To determine high priority operational
needs

Based on a survey distributed to all BMEDs and information we gathered
during our site visits, the following is a high-level summary of the
immediate needs:

All sites have minimal manuals. The following are
needed at most sites: Dräger Savina (ventilator), Primedic Def
Eco1 (defibrillator), and GE Dash 2000 (also need service codes).

Training

Technical: All staff have a strong theoretical
technical background, but need to further develop their troubleshooting
skills and medical theory (e.g., equipment use). Manufacturer
training on Dräger ventilators and anaesthesia equipment is also
required.

3. To foster strategic relationships to
help build future capacity

In addition to meeting with the MoH Regional Health Directors,
healthcare administration, and the BMEDs
during our tours through the regions, meetings were also arranged with
other key stakeholders, including
vendors (Medica and Meditech), NGOs (WHO, Unicef, IBM), Educators (Don
Bosco Technical School) and with the new Minister of Health. Although
the mentors initiated the meetings, the main purpose of all these
meetings was to initiate HTM discussions among these various groups and
work with BME to create solutions. The first inter-Kosova BME meeting
was successfully held on Dec. 18th 2004 during which all regional BME.
Supervisors actively participated.

Action Items
An action plan is summarised in this Report. Key items include:
1. Implement a new organisation structure that formally connects the
BMEDs together as well as link them strategically to the MoH. BME
budgets must accompany this structure for parts, labour and training.
2. Develop and strengthen the communication and support network for
BME.
3. Use this network to address and promote current BME issues (e.g.,
resources and immediate needs).
4. Implement high priority HTM project (e.g., inventory, scheduled
maintenance) with mentoring and support from the network.